Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Hepatitis C kills more Americans than all other infectious diseases combined

scopeblog.stanford.edu

Post reply on HN
Print view View original

211–220 of 276 posts

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#211

Post by heisenzombie »

vilhelm_s wrote: post #144
phkahler wrote: post #129

Earlier quoted context omitted.

>> They're priced this way because they're 80-90% cheaper than the previous treatment. Your statement is true. But it also hints at another problem, which is that the default is to price life saving treatments as high as the market will bear. It's a pricing model in line with extortion, the only exception being that the extortionist doesnt have to threaten to kill you - the virus or whatever condition is already maki…

I think it's the "right" price, you want to incentivize companies to try to develop drugs that will do the maximal amount of good. Like, you could imagine a system where you don't have a free market at all, the government would directly fund both medical treatment (like in Europe) and medical research (like nowhere right now, but you could imagine nationalizing the drug companies). So then, before the hepatitis-c dru…

I’m not sure that assertion is borne out by the data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

I think two big missing factors in your analysis are (1) profit — US drug companies pocketed something around $30 billion dollars this year, and (2) inefficiency - something like $20 billion dollars went into deg marketing in the US for example, which seems to me like almost a complete waste.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#212

Post by masonic »

3fe9a03ccd14ca5 wrote: post #91
coder1001 wrote: post #20

Earlier quoted context omitted.

or go to India now and be treated for $1k [1]? [1] https://www.medicaltourismmag.com/article/hepatitis-c-treatm...

It’s basically to the point where it’s: > Go to and be treated for

Go to and be treated for

FTFY

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#213

Post by ohyes »

lawn wrote: post #14
ohyes wrote: post #4

Earlier quoted context omitted.

It’s priced based on ability to pay. US it will be 100,000 other countries it will be less.

Ability to pay? Is that a joke? Considering that 40% of Americans can't cover a $400 emergency expense[0], what makes you think they can pay $84,000 for a 12-week treatment? [0]: https://money.cnn.com/2018/05/22/pf/emergency-expenses-house...

Americans tend to go into massive medical debt, still they can have that credit extended to them because over their careers they’ll make more than 84,000 and probably pay it off if they live.

Collecting part of that amount is still profitable because there’s no basis in the actual cost of treatment rendered.

Compare to someone in (poor country) who is lucky to collect a few hundred dollars a year, no one will ever extend that person 84,000 in debt, because they don’t have any chance of making that amount over the course of their entire career.

Ability to pay is significantly different from “savings.”

The $400 emergency expense number is about having savings (extra money in the bank) which is really a complicated issue relating to financial literacy and debt to income ratios. You could have someone making 6 figures living in an expensive house, driving a nice car, who can’t come up with $400 because he’s overextended himself. It’s a question of liquidity rather than ability to pay. If his wages get garnished, maybe he loses the house and has to sell the car, but the medicine still gets paid for.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#214

Post by phonon »

lotsofpulp wrote: post #105
phonon wrote: post #90

Earlier quoted context omitted.

What percentage of the recepients costs are insurance related overhead as well? (Yes, that includes the time doctors spend arguing with insurers).

Surely, there is room for optimization, but in the alternative case of taxpayer funded healthcare, I'm sure the government is going to ask doctors for justifications for the same reasons insurers do. Someone needs to provide a second opinion on whether or not procedures and medications are appropriate for accountability purposes.

Fraud in government programs have much harsher criminal penalties and are more aggressively pursued.

https://www.propublica.org/article/health-insurers-make-it-e...

https://www.propublica.org/article/we-asked-prosecutors-if-h...

https://www.propublica.org/article/how-to-make-health-insure...

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#215

Post by joe_the_user »

jxramos wrote: post #163

Here's the crux point... """ ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects. "With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or doe…

All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place.

Sure, some portion of people in distress contribute overall very disproportionately to health care cost. This includes people who make poor health choices (over-consumption of sugary beverages, unhealthy drug and similar things), people who are homeless and people who chronic health problems (through work-related injuries, random chance or actual poor decisions).

There seem to be two reaction: "OK, then just don't allow them health care, problem solved" or "we need to prevent people from getting into that position in the first place."

I would say the first reaction is counter-productive, poorly thought-through and morally indefensible. Obviously, I think the second approach is crucial (obviously requiring quite a bit of effort). The first position is very common, however and it's kind of sad, for both the people who think this way but much more for the consequence.

I think the only reason people jump to the first position is: A. The situation is presented in isolation and these people aren't considering the consequences. B. There's a human tendency to jump to a belief without fully exploring the evidence. C. Defending a belief often just makes the defender more defensive, especially since changing would make them admit they holding a fairly cruel and immoral position.

I think the article from a couple days ago about human belief formation is very relevant for this discussion.

see: https://www.youtube.com/watch?v=bvebjL48f-w&feature=youtu.be

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#216

Post by masonic »

save_ferris wrote: post #5
yakz wrote: post #2

Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000. The price of other hepatitis C drugs is also high: Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatmen…

That is so depressing to read. US pharma companies are completely out of control, there’s absolutely no reason a 12 week treatment should cost around the mean annual US income. Can’t imagine having to decide to risk my entire financial future to deal with Hep C.

  US pharma companies are completely out of control
You are free to choose not to use any meds or therapies developed by US pharma companies. Fight the Power!

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#217

Post by timthorn »

sorokod wrote: post #194
DoofusOfDeath wrote: post #192

Earlier quoted context omitted.

This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals. As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems. On the other hand, as someone with chronic mild obesit…

"This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals" It's a moral question, not a political one. Food for thought: "Rough sleeper gives birth to twins outside wealthiest Cambridge college" - https://www.theguardian.com/society/2019/dec/26/rough-sleepe...

But that story isn't about costs of healthcare - the NHS will treat her for free precisely because the costs are socialised. The social care system will also ramp up rapidly given she's a vulnerable new mother who has now been admitted to the local maternity hospital.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#218

Post by masonic »

inasio wrote: post #199
jp57 wrote: post #170

The article says nothing about the false positive and false negative rates of the test, and proceeds as if the screening is infallible. Even given what was said in the article, one has to assume that the incidence of the infection in the general population is quite low—probably measured in basis points—which means that the false positive rate of the test would have to be very low to get a high positive predictive val…

The two key groups in western countries are baby-boomers (likely acquired the infection from dentists/doctors reusing needles), and intravenous drug users. The best bang for your buck is in testing and treating this last population, but you have to be careful and try to do followups to prevent reinfection. It's worthwhile to test the baby boomer population as many of them could require liver transplants soon if not d…

   (likely acquired the infection from dentists / doctors reusing needles)
In Western countries?!

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#220

Post by PierceJoy »

chimeracoder wrote: post #201
blacksmith_tb wrote: post #185

Earlier quoted context omitted.

Absolutely - but inexpensive testing may not help much when the cost of treatment is in the tens of thousands of dollars[1]. 1: https://www.medicalnewstoday.com/articles/323767.php#drug-ty...

> the cost of treatment is in the tens of thousands of dollars[1]. It really isn't. That's like walking in to a car dealership, asking how much the car is, and then accepting the salesman's first offer at face value. In reality, insurance will typically cover HCV treatment in the US. Because there's so much competition between HCV drugs, the insurers are able to negotiate deals that are less than a tenth of what the…

The parent comment was replying to a suggestion they partner with organizations who typically help low income and homeless people. I doubt most of them have insurance.
Post reply on HN